食管pH和胆汁监测用于十二指肠胃食管反流的诊断及对治疗的评价  

Esophageal pH and bile monitoring for detecting duodenogastroesophageal reflux and evaluating the effectiveness of treatment.

作　　者：林金坤[1] 胡品津[1] 李初俊[1] 邓会芬[1] 陈为[1] 

机构地区：[1]中山医科大学第一医院消化科,广州510080

出　　处：《中华消化杂志》2001年第10期602-604,共3页Chinese Journal of Digestion

基　　金：广东省自然科学基金资助 ( 0 0 134 2 )

摘　　要：目的　探讨十二指肠胃食管反流 (DGER)的诊断方法和胆汁反流在胃食管反流病(GERD)中的临床意义。方法　用便携式 pH监测仪及胆红素监测仪 (Bilitec 2 0 0 0 )对 2 0例健康人及 5 2例有烧心、反酸等症状的患者行 2 4h食管腔内 pH和胆红素同步监测 ,以光吸收值≥ 0 .14作为发生胆汁反流的阈值 ,计算 2 4h反流总时间 %等指标。并对 15例酸和胆汁混合反流者用铝碳酸镁加西沙必利治疗 4周 ,然后复查两项监测。结果　 2 0例健康人中未发现病理性酸反流 ,5 2例患者中有 4 7例 (包括食管炎 12例 )存在病理性酸反流 ,诊为GERD。胆汁反流总时间 %在健康人组及反流症状组分别为( 0 .4 7± 0 .71) %及 ( 2 .67± 3 .2 3 ) % (P <0 .0 5 ) ,在食管炎及非食管炎者分别为 ( 5 .4 1± 4 .93 ) %及 ( 1.68± 1.76) % (P <0 .0 5 )。 4 7例GERD中 15例 ( 3 2 % )为酸及胆汁混合反流 ,另 3 2例为单纯酸反流 ,前者有食管炎 8例而后者仅为 4例 (P <0 .0 5 )。 15例混合反流经治疗后酸和胆汁反流总时间 %均明显降低 ,8例食管炎中有 7例炎症消退 ,1例减轻。结论　Bilitec 2 0 0 0是评价DGER的有用工具 ,3 2 %的GERD存在酸和胆汁混合反流 ;胆汁反流在GERD食管黏膜损害中起重要作用。Objective To study the diagnostic methodlogy of duodenogastroesophageal reflux (DGER) and to evaluate the role of bile reflux in gastroesophageal reflux disease (GERD). Methods Simultaneous 24 hour esophageal bilirubin levels and pH monitoring were performed in 20 healthy subjects(HS) and 52 patients with symptoms suggesting gastroesophageal reflux with Bilitec 2000 apparatus and Digitrapper MKⅢ ambulatory pH recorder. An absorbance value ≥0.14 was designated as the threshold value for the presence of bile reflux. Patients suffering from mixed pathologic reflux of acid and bile were treated with hydrotalcite and cisapride for four weeks, then the monitorings were repeated. Results No pathologic acid reflux were found in 20 HS. Fourty seven of 52 patients were found to have pathologic reflux by 24 hour esophageal pH metry. The total fraction time of bile reflux was higher in 52 patients than those in 20 HS (2.67%±3.23% vs. 0.47% ± 0.71% , P <0.05), and was higher in 12 patients with esophagitis than in 35 patients without esophagitis (5.41%± 4.93% vs. 1.68% ±1.76%, P <0.05). Among 47 patients with GERD, 15(32%) showed abnormal acid and bile mixed reflux. Eight cases of esophagitis were found in 15 patients with mixed reflux and only 4 cases of esophagitis in the 32 patients with acid reflux alone ( P <0.05). After treatment with hydrotalcite and cisapride, the total fraction time of acid and bile reflux in 15 patients with mixed reflux decreased significantly ( P <0.05), and the esophagitis were healed in 7 of 8 patients. Conclusions Bilitec 2000 may be a useful tool for detecting DGER and evaluating its treatment. About 32%(15/47) of patients with GERD were found to be DGER. Bile reflux may play a significant role in esophageal mucosal damage of GERD.

关 键 词：胃食管反流 食管炎 胆汁反流 食管黏膜损伤 PH监测仪 胆红素监测仪 

分 类 号：R571[医药卫生—消化系统]